About half of our adolescent and adult clients suffering from anorexia, bulimia, and compulsive eating disorders report having loving parents and a safe home environment. Clients often feel guilty about having an eating disorder when they encounter others who have a history of serious trauma. These clients sometimes feel as though they don’t “deserve” to have their eating disorder.
If you have a friend or family member who you suspect struggles with disordered eating or disordered exercise, and you want to speak to them about seeking treatment, start with these foundations in mind:
Know that your talk with them may not seem to have an impact at the time.
Since many eating disorder behaviors are considered positive signs of discipline by individuals with them, they may disregard concern about them as threats to their hard earned efforts (to lose weight, omit food groups, over exercise, etc).
Other behaviors are highly secretive and shameful to individuals and require great sensitivity if brought up. It may be they deny having a problem, but another’s kindly spoken observations are helpful to break down denial and encourage seeking help.
Speak the truth, then let go of the results.
It takes courage to speak up, and an act of deep kindness. It is also important to let go of attachment to the results. We only grow when we become open to growing and no one else can decide when that will be. Your communication may add to the factors leading to someone’s decision to get help, but that is all.
How to Approach the Talk
Organize your thoughts
It helps to have an opening statement about wanting to talk, and being honest that you may be nervous or this talk might be difficult.
Have in mind sharing any similar struggles in your past, using a bit of self disclosure as a way of normalizing and de-shaming their potential struggles. Any type of emotional issue or addiction of your own may be worth acknowledging….
Some “Do’s” and “Don’ts”
DO speak with compassion. Keep in mind we all find maladaptive coping strategies that do seem to work initially. Most of us will find ourselves suffering from some form of emotional problem at some point in our lives, so come at it as a fellow human on a learning journey…
DO know that our culture has ‘disordered eating.’ In other words, everywhere we turn, weight, eating advice, exercise advice and body image are topics of conversation. It is no wonder both genders and people of all ages get drawn into what is a disproportionate emphasis on body image and “healthism.” As a result, many young people feel that their obsessive relationship to body image or eating is quite normal these days!
DO speak with respect for that individuals’ attempt at self- improvement, which may have gotten out of hand. Appreciating their initial effort to try to get healthy, or lose weight can help lessen defensiveness now that their behaviors may be out of control.
DON’T come across in an accusatory manner. It just backfires.
DON’T list the health risks of suspected eating disorder. People with ED’s don’t respond to health risks as concerning and more than telling an addict that their addiction isn’t healthy. It just creates more anxiety, which can drive the disorder deeper.
DON’T bring up other people and their concerns, like “your sister is worried about you too.” Keep the feedback from you and about your concerns.
DON’T refer the patient to nutritionists that are not dietitian specialists. Do not refer this person to health practitioners likely to make nutrition recommendations, as ANY nutrition advice at this point only furthers the disorder. Well- intentioned practitioners that make diet or exercise recommendations (be it a personal exercise coach, a holistic practitioner) adds more fuel to the growing list of “good” versus “bad” foods.
DON’T use patronizing statements like, “You are smarter than this”, “You know better” or anything implying shame in having a disorder.
DON’T talk too much or too long. Keep your statements short and to the point. Otherwise you lose that person’s attention and interest in what you are saying.
Who or Where to Refer to?
If the fear in getting treatment is related to a fear of gaining weight, the person may be more willing to see a dietitian specializing in eating disorders first. It may seem less threatening to have their diet or metabolism analyzed for nutrition or exercise physiology advice rather than consider going to a therapist.
Psychologically trained dietitians know how to work with restrictive eating, bulimia and emotional overeating and will refer that patient to a psychotherapist soon after getting a safe attachment with the client. A dietitian may be the place to start in people that don’t want to admit to a disorder.
Recommending someone to an individual provider might be a good place to start, but referring to an inpatient treatment center is also a possibility, either way, a treatment center would be able to assess the situation and determine the appropriate way to proceed based on the duration and persistence of the symptoms, the individual’s location, mental and physical state, etc.
Our staff at Ai Pono Hawaii would be happy to speak with you or your loved one in-depth about our treatment options and figure out a plan that makes sense for you.
Written by Francie White, MS, RD, Co-Founder of Central Coast Treatment Center; edited by Ai Pono Hawaii Staff Contributor
What are you hungry for?
In Dr. Anita Johnston’s book, Eating in the Light of the Moon, she describes two containers we carry through our life. One for food and one for all the other things we need to ‘fill’ ourselves.
“Imagine that within us we all have two containers that we carry on our journey through life. One is a gourd-shaped vessel for carrying food and water, and the other is a heart-shaped basket for carrying all the things we need to make our life meaningful and fulfilling. The gourd is what we fill when we need physical nourishment. It is to be filled with food. The basket is what we fill when we need emotional nourishment. It is to be filled with attention, affection, appreciation and other 'foods' for the heart and soul.”
Scenario 1: Deserved hunger
The children are finally asleep and her husband’s snoring reveals it’s her time to have some “me” time. She doesn’t feel hungry, but she deserves some attention.
What does this entail tonight? Is it ice cream carefully hidden behind the frozen vegetables, or is it the bag of chocolate covered almonds calling from the back of her drawer?
Scenario 2: Never enough
It has been a very long day and an hour commute. After disarming the house alarm and throwing her briefcase on the couch, she kicks off her practical heels and heads for the leftover cheesecake from her staff meeting last night.
Quickly, as if all the woulda, coulda, shoulda people in her life were coming in five minutes to criticize her, she takes a bite. The taste is smooth and sweet. Bite after bite, she goes into a sugar-induced numbness as the stress of the day blurs.
Now the cheesecake is gone. She feels sick to her stomach, and what was a rush of sugar is now a nauseous headache. What’s worse, she’s still wanting to eat. She’s still wanting more, but physically full.
Scenario 3: Comparison, the thief of satiety
She’s a beautiful, young woman who has an hourglass figure and dark, smoldering eyes. Her beauty stuns and her confident walk keeps the non-serious men away. She is admired by all. With all of this, she is still unaware of her transformation from ugly duckling to swan.
Her best friend's thin and curvy body, long blond hair, and sun-kissed features have always attracted attention. She appears to not ever be interested in food, so it seems she doesn’t struggle with her looks or weight. She flashes by enjoying the glances from every man in the room.
Both friends love each other and know that they are completely different, yet the comparisons happen. One goes home and munches on her chips while the other goes another day without food. They both are hungry, and they both aren’t getting full.
Getting to know our hungers
These different types of hunger can be difficult to identify one our own, especially when we are in the throes of an eating disorder, but understanding what we are truly hungry for is key to a healthy relationship with food and with ourselves. Through group and individual sessions, therapists at the Ai Pono Hawaii treatment center for women with eating disorders are here to help you distinguish your containers and recognize which one needs satisfying.
If you are interested in learning more about our program or intuitive eating approach, you can read about our philosophy here.
Join Dr. Anita Johnston in “Podcasting in the Light of the Moon with Dr. Anita Johnston: Part 2- Diet Culture, Fat Shame, and Eating Disorders”. In this second part to the podcast Dr. Anita Johnston talks about:
• How the stories in our minds influence how we live our lives
• How we learn “fat is bad”
• Dr. Johnston’s experience growing up without diet culture
• How diet culture contributes to the development of eating disorders
• Recovery as a counterculture move toward health
• Body, weight, food, and recovery-positive social media and community
• Letting go of the diet mentality
• How the eating disorder blocks emotions
• Light of the Moon Café
• Fate and Destiny in recovery
(if you missed part one of this podcast you can view it here)
Dr. Anita Johnston, Clinical Director and founder at ‘Ai Pono Maui and author of “Eating In the Light of The Moon”, speaks in this episode, “Podcasting in the Light of the Moon with Dr. Anita Johnston: Part 1- Finding Meaning in the Struggle” and discuss the following:
• Finding joy in the recovery process
• Can people completely recover
• The steps and journey toward full recover
• The meaning, metaphor, and symbols of the eating disorder
• Understanding how your eating disorder has served a function
• How to begin letting go of the eating disorder
• The treasures you will discover in yourself through recovery
• Using curiosity as a skill for recovery
Imagine an integrated treatment program from the coast of Maui to the coastlines of California’s Santa Barbara and San Luis Obispo! Ai Pono Maui, Maui’s residential treatment center for women struggling with eating disorders, has recently teamed up with California based Central Coast Treatment Center for Eating, Exercise and Body Image Disorders. Dr. Anita Johnston of ‘Ai Pono Maui and Francie White of Central Coast Treatment Center join together in one of most innovative forces in treatment – over three decades of success bursting through with a new level of treatment like never before. Stay tuned for more information!
Anita Johnston, Ph.D. is the Founder of the ‘Ai Pono Intensive Out-Patient Eating Disorders Programs in Honolulu and ‘Ai Pono Maui. Read excerpts from Dr Anita Johnston’s blog here: http://dranitajohnston.com/blog Or visit support site In the Light of the Moon Cafe here: http://lightofthemooncafe.com/. The Light of the Moon Cafe’ is an online e-course and support circle for women around the globe seeking freedom from struggles with eating and weight issues.